Getting Back On Track: How Bone Metastases Are Treated
Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself, including:
Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses practicing relaxation methods like meditation, physical therapy, or yoga and doing other gentle forms of exercise. Ask your health care team about programs that can help keep you safely active. Strong muscles protect bones, stresses Huston, and being active makes you feel better both physically and psychologically.
Possible Symptoms Of Advanced And Metastatic Cancer
General signs and symptoms of advanced and metastatic cancer can include:
- Loss of energy and feeling tired and/or weak: This can get so bad that you may have a hard time doing everyday tasks like bathing or getting dressed. People with advanced cancer often need help with these things.
- Weight loss
- Shortness of breath or trouble breathing
Advanced and metastatic cancers can cause many other symptoms, depending on the type of cancer and where it has spread.
Survival Rates Of Stage 4 Breast Cancer
Unfortunately, cancer cells often become more difficult to treat and may develop drug resistance once they spread. According to the Australian Institute of Health and Welfare , the 5-year survival rate for women whose breast cancer is metastatic at first diagnosis is 32%, compared to the 91% on average for all breast cancer patients.
Factors affecting survival rate of metastatic breast cancer
Survival rates can provide an estimate of what percentage of patients with the same stage of breast cancer are still alive after a certain period of time . However, they cannot predict how long any specific individual with breast cancer will live. The length of survival time for people with metastatic breast cancer can vary significantly from person to person, but there are a number of factors which can influence this including:
- Response to treatment
- The extent and location of metastases
- The presence of other health issues not related to cancer
- The specific subtype of breast cancer . This is very important, as some types of cancer can be more aggressive than others and respond differently to treatment.
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Breast Cancer Subtypes Hormonal And Her2 Status And Survival Rates
Many research studies over the years have shown that Estrogen-positive breast cancers have better survival rates than all of the Estrogen-negative subtypes.
Progesterone-positive breast cancer also appears to have improved survival rates in comparison to progesterone-negative cases.
A recent research study combines hormone receptivity, HER2 status and stage and found some interesting results:-
For ER+ sub-types survival rates were significantly better than all other subtypes. For example, at stage 1b,
ER+ PR+ HER2- 5-year survival rates were 98.6%ER+ PR- HER2+ 5-year survival rates were 97.3%
The subtype triple negative breast cancer had the worst survival rates over all three stages. At stage I the 5-year survival rate was 92.9% and at stage III 48.9%.
Tests To Diagnose Metastatic Breast Cancer
If you have any of the symptoms of metastatic breast cancer, your doctor may recommend one or more of the following tests:
- blood tests
- whole-body bone scan, with or without X-rays of specific bones
- MRI of the spine or brain
- CT scan of the chest, abdomen, pelvis, and/or brain
- PET scan
- X-ray or ultrasound of the abdomen or chest
- bronchoscopy if you have a constant cough or trouble breathing
- biopsy of any suspicious area
- a “tap,” removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall and a spinal tap removes fluid from around the spinal cord
You can read the following pages for information on symptoms of breast cancer metastasis and diagnosis:
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Disease Free Intervals And Prognosis In Metastasis
The time that passes between the primary diagnosis and treatment of breast cancer and a diagnosis of metastasis is also of prognostic significance.
A 2015 medical study from the Netherlands looked at 815 patients with metastatic breast cancer between 2007 and 2009 in eight hospitals.
Of these 815 patients, 154 had metastatic spread at diagnosis. 176 patients had a metastatic free interval of less than 2 years and 485 patients had been metastasis-free for longer than 2 years.
The ladies presenting with metastatic breast cancer at diagnosis had a longer survival rate than those who experienced a recurrence at distant sites in under 2 years from the initial diagnosis of breast cancer.
However, there were no differences in survival rates between those diagnosed at Stage IV and those women who had metastatic spread over 2 years after an original breast cancer diagnosis and treatment.
Furthermore, some medical studies show that survival rates vary for different types and subtypes of breast tumors according to the time intervals of recurrence. So, for example, breast cancer survival rates comparing two cancers may be better at a 5-year interval for some cancers but even out over 15 years.
Metastatic Breast Cancer Treatment And Planning
After a diagnosis of metastatic breast cancer, its helpful to take all the time you need to gather information and make decisions about your treatment. Learn about the medical specialists that may be involved in your care, treatment options, genetic testing, taking a break from treatment, and more.
SurgeryDoctors sometimes recommend surgery for metastatic breast cancer in order, for example, to prevent broken bones or cancer cell blockages in the liver. Learn more.
ChemotherapyChemotherapy is used in the treatment of metastatic breast cancer to damage or destroy the cancer cells as much as possible. Learn more.
Radiation TherapyYour doctor may suggest radiation therapy if youre having symptoms for reasons such as easing pain and controlling the cancer in a specific area. Learn more.
Hormonal TherapyHormonal therapy medicines are used to help shrink or slow the growth of hormone-receptor-positive metastatic breast cancer. Learn more.
Targeted TherapyTargeted therapies target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Learn more.
Local Treatments for Distant Areas of MetastasisLocal treatments are directed specifically to the new locations of the breast cancer such as the bones or liver. These treatments may be recommended if, for example, the metastatic breast cancer is causing pain. Learn more.
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Our Advice To Other Women With Metastatic Breast Cancer: Be Nice To Yourself
Give yourself a break! is the advice that Sendelbach offers. Stop negative self-talk about what you should have done but didnt do, she says. If you have MBC, you need to be kind and loving to yourself.
The body has only so much energy to offer per day, and managing metastatic breast cancer requires a lot of it. So it doesnt make sense to try to compare what youre able to do with what your cancer-free friends are accomplishing.
Just getting through the day can be hard, Sendelbach says. Getting rid of those not good enough feelings can lift a huge weight off you.
How Is Electrochemotherapy Given
Many people need only a single treatment of electrochemotherapy, although it can be repeated in the same area or used to treat a different area.
Treatment is usually carried out as an outpatient or day case, though some people may need to stay in hospital overnight. This depends on how much treatment is needed and your general health.
It can be given under general anaesthetic or sometimes local anaesthetic, depending on the size of the area or how many areas need to be treated. You may be given pain relief beforehand.
The chemotherapy is usually given into a vein . It can also be given by injection directly into the area of cancer being treated .
Bleomycin is the chemotherapy drug most commonly used. Cisplatin, another chemotherapy drug, may also be used.
A short time after the chemotherapy drug is given, electrical impulses are given directly to the area using an electrode with the help of a specially designed needle probe. The electrode may be applied a number of times to make sure the whole area is treated. The procedure usually takes about 30 minutes depending on the size of the area.
Afterwards, the area will often be covered with a dressing that may need changing regularly. The treated areas will usually scab over. Often the areas look worse before any improvement is seen.
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Treatment For Secondary Breast Cancer
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team .
Your doctor and nurse will talk to you about the best treatment for you. They will also ask you about your preferences. They will talk to you about things to consider when making treatment decisions. You may have some treatments as part of a clinical trial.
Secondary breast cancer can be controlled, often for many years, but it cannot be cured. Because of new and improved treatments, women with secondary breast cancer are living for longer. The aim of treatment is to control the cancer, improve the symptoms and help you to live well for longer.
The treatment you have will depend on:
- where the cancer is in your body
- if it is ER positive or HER2 positive
- previous breast cancer treatment you have had.
You may have a combination of treatments.
Treatments for secondary breast cancer include:
Breast Cancer Is A Heterogeneous Disease
Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.
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Local And Regional Recurrence Of Breast Cancer
Breast cancer that comes back in the breast, chest, scar or lymph nodes nearby is called a local or regional recurrence. This is not secondary breast cancer. If you have a local or regional recurrence, you may have tests to check the cancer has not spread to other parts of the body.
We have more information about breast cancer recurrence.
Myth #: People With Metastatic Breast Cancer Have A Short Amount Of Time Left
While some people mistakenly think MBC is curable, at the other extreme are those who assume its an immediate death sentence. But there is a big difference between stage IV incurable cancer, which MBC is, and terminal cancer, which can no longer be treated. A person isnt automatically terminal when she or he gets a metastatic diagnosis. Although MBC almost certainly will shorten someones life, it often can be managed for years at a time.
As Illimae of Houston points out: Stage IV is not an immediate death sentence. It feels that way at first but many have months/years of reasonably decent condition. Brain mets are not necessarily the end either. When found early and treated, especially with minimal disease in the body, life can resume to a fairly normal state.
Mermaid007 adds: hen I was diagnosed with bone mets I felt I needed to go home and get my affairs in order when here I am 4 and half years later.
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What Is The Prognosis For Triple Negative Breast Cancer
Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
- Brain: 7.3%
- All less common sites: 22.4%
Invasive lobular carcinoma tends to have a significantly different pattern of metastases than ductal breast cancer. In one 2017 study, almost 70% of people with metastases from lobular carcinoma had peritoneal metastases.
For roughly a third of women , cancer spreads to multiple organs at the same time.
Myth #: Metastatic Breast Cancer Is Curable
Whether metastatic breast cancer is someones first diagnosis or a recurrence after treatment for earlier-stage breast cancer, it cant be cured. However, treatments can keep it under control, often for months at a time. People with MBC report fielding questions from family and friends such as, When will you finish your treatments? or Wont you be glad when youre done with all of this? The reality is they will be in treatment for the rest of their lives.
A typical pattern is to take a treatment regimen as long as it keeps the cancer under control and the side effects are tolerable. If it stops working, a patient can switch to another option. There may be periods of time when the cancer is well-controlled and a person can take a break. But people with MBC need to be in treatment for the rest of their lives.
As Breastcancer.org Community member Vlnprh of Wisconsin comments: The vast majority of people have no idea what MBC treatment involves. They somehow think that you will undergo something similar to early-stage patients surgery, radiation, chemo, whatever and then be done. They want to see you as a pink-tutu-wearing cheerleader jumping up and down declaring that you have beaten this disease
Amarantha of France writes: The one I get over and over is, How long will you be on this chemo? I mean doesn’t it end sometime? Yes, it ends when it stops working and then we go on to another treatment lather, rinse, repeat I guess until we run out of options.
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How Does Breast Cancer Spread
Breast cancer can invade and grow into the tissue surrounding the breast or it can travel to other parts of the body and form a new tumor there. Nearly all types of cancer have the ability to spread , but whether or not it will spread is often linked to what type of breast cancer you have.
Breast cancer can spread in three ways:
Every cancer is different, but the type of breast cancer you have typically plays a role in how aggressive or slow moving it is and where its most likely to spread, says Dr. Roesch.
Stages Of Breast Cancer And What They Mean
Breast cancer stages are usually expressed on a scale of 0 to 4.
Stage 0 is considered non-invasive breast cancer, with no evidence that the cancer has spread beyond the part of the breast where it began to grow, including to nearby lymph nodes.
Stages 1 to 3 generally describe breast cancer that may have spread to other parts of the breast and nearby lymph nodes, with stages increasing with the size of tumors and extent of spread.
Cancer that remains localized to the breasts is the most treatable.
Breast cancer tumors can grow directly from breast tissue to other nearby locations, such as the chest wall or the skin of the breast. This is considered stage 3 breast cancer.
Stage 4 is metastatic breast cancer , meaning that cancer that originated in the breast has now spread to other parts of the body.
In stage 4 breast cancer, cancer cells can spread beyond the breasts by invading lymph nodes near the breast and traveling to other parts of the body via the lymphatic system.
Cancer cells also can move through the bloodstream to inhabit other organs and regions of the body.
The most common destinations for MBC or advanced breast cancer cells are the brain, bones, lungs, and liver.
The outcome for Stage 4 breast cancer that has metastasized, or spread to distant organs of the body, is considerably lower than for earlier stages, with a 28 percent 5-year survival rate.
symptoms of MBC can vary, depending on where the cancer has spread.
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Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Connecting and speaking with others who have gone through a similar experience can also be helpful. Cancer Council runs support groups all across Australia which can provide support and information for people with cancer and their families. Groups in each state can be accessed here:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.